Transfer of orbital angular momentum of light to plasmonic excitations in metamaterials

The emergence of the vortex beam with orbital angular momentum (OAM) has provided intriguing possibilities to induce optical transitions beyond the framework of the electric dipole interaction. The uniqueness stems from the OAM transfer from light to material, as demonstrated in electronic transitions in atomic systems. In this study, we report on the OAM transfer to electrons in solid-state systems, which has been elusive to date. Using metamaterials (periodically textured metallic disks), we show that multipolar modes of the surface electromagnetic excitations (so-called spoof localized surface plasmons) are selectively induced by the terahertz vortex beam. Our results reveal selection rules governed by the conservation of the total angular momentum, which is confirmed by numerical simulations. The efficient transfer of light's OAM to elementary excitations in solid-state systems at room temperature opens up new possibilities of OAM manipulation.

Computational fluid dynamics study of the pharyngeal airway space before and after mandibular setback surgery in patients with mandibular prognathism

The purpose of this study was to investigate the relationship between the pressure drop in the pharyngeal airway space (ΔP_PAS) and the minimum cross-sectional area (minCSA) of the pharyngeal airway before and after mandibular setback surgery using computational fluid dynamics, in order to prevent iatrogenic obstructive sleep apnoea. Eleven patients with mandibular prognathism underwent bilateral sagittal split osteotomy for mandibular setback. Three-dimensional models of the upper airway were reconstructed from preoperative and postoperative computed tomography images, and simulations were performed using computational fluid dynamics. ΔP_PAS and the minCSA of the pharyngeal airway were calculated, and the relationship between them was evaluated by non-linear regression analysis. In all cases, the minCSA was found at the level of the velopharynx. After surgery, ΔP_PAS increased significantly and the minCSA decreased significantly. The non-linear regression equation expressing the relationship between these variables was ΔP_PAS=3.73×minCSA^-2.06. When the minCSA was <1cm², ΔP_PAS increased greatly. The results of this study suggest that surgeons should consider bimaxillary orthognathic surgery rather than mandibular setback surgery to prevent the development of iatrogenic obstructive sleep apnoea when correcting a skeletal class III malocclusion.

Cervicofacial subcutaneous emphysema associated with dental laser treatment

Cervicofacial subcutaneous emphysema is a rare complication of dental procedures. Although most cases of emphysema occur incidentally with the use of a high-speed air turbine handpiece, there have been some reports over the past decade of cases caused by dental laser treatment. Emphysema as a complication caused by the air cooling spray of a dental laser is not well known, even though dental lasers utilize compressed air just as air turbines and syringes do. In this study, we comprehensively reviewed cases of emphysema attributed to dental laser treatment that appeared in the literature between January 2001 and September 2012, and we included three such cases referred to us. Among 13 cases identified in total, nine had cervicofacial subcutaneous and mediastinal emphysema. Compared with past reviews, the incidence of mediastinal emphysema caused by dental laser treatment was higher than emphysema caused by dental procedure without dental laser use. Eight patients underwent CO2 laser treatment and two underwent Er:YAG laser treatment. Nine patients had emphysema following laser irradiation for soft tissue incision. Dentists and oral surgeons should be cognizant of the potential risk for iatrogenic emphysema caused by the air cooling spray during dental laser treatment and ensure proper usage of lasers.

Visualization of Flow Instabilities for High Density Polyethylene

Two typical flow instabilities of “Shark Skin” and “Melt Fracture” for high density polyethylene were investigated in this report. Experimental measurements were carried out methodically in a wide flow region from the reservoir (entry region) to the die land with a specific slit die. Especially the flow pattern was visualized with a high speed camera and the frequency of the flow instability was analyzed. Corresponding to the visualization analysis, the pressure fluctuation in the slit die and the surface roughness at the die exit were measured simultaneously and these frequency characteristics were analyzed with a FFT (Fast Fourier Transform) analyzer. As for “Shark Skin” region, the irregularity of the surface roughness in the broad frequency band was recognized at the die exit. In spite of this surface roughness, the pressure fluctuation and the fluctuation of the flow pattern at the wall vicinity in the die land were not observed. These results indicate that “Shark Skin” occurs at the die exit. As for “Melt Fracture” region, the periodical oscillation of the flow pattern and the periodical pressure fluctuation which corresponded to the periodical distortion of the extrudate was recognized in the die land. However the periodical oscillation of the flow pattern and the periodical pressure fluctuation could not be recognized in the reservoir (entry region of the die land). These results indicate that “Melt Fracture” is initiated at the die entry and occurs in the die land. Consequently it is clarified that “Shark Skin” occurs at the die exit and the flow instability which lead to “Melt Fracture” is initiated at the die entry and occurs in the die land.

HLA and SNP haplotype mapping in the Japanese population

The genes that encode the human leukocyte antigen (HLA) class I and II molecules are highly polymorphic and located in the major histocompatibility complex (MHC) region, where there is a high density of immune-related genes. Numerous studies have identified disease susceptibility in this region; however, interpretation of the results is complicated because of the strong linkage disequilibrium (LD) among HLA alleles and single-nucleotide polymorphisms (SNPs). In this study, we evaluated the correlation between the HLA alleles of 6 loci (HLA-A, C, B, DRB1, DQB1 and DPB1) and 6502 SNPs within 8 Mb of the extended MHC region using 92 Japanese subjects to identify SNP single loci or haplotypes that tag HLA alleles. We found a total of 39 HLA alleles that showed strong LD (r(2)≥0.8) with SNPs, including 11 non-synonymous SNPs in non-HLA genes. In addition, we identified several SNP haplotypes in strong LD (r(2)≥0.8) with eight HLA alleles, which do not possess tag SNPs. Our detailed list of tag SNPs and haplotypes could be utilized for a better understanding of the results obtained by association studies in the Japanese population and for the characterization of the differences in LD structures between races.

Tuning of the fluorescence wavelength of CdTe quantum dots with 2 nm resolution by size-selective photoetching

Photoetching of CdTe nanocrystals was applied to thiol-capped CdTe quantum dots (QDs) to control their fluorescence wavelength. CdTe QDs with a high quantum yield (49%) were synthesized in aqueous solution, and they were successfully photoetched in strong alkaline (pH = 13.5) conditions. When monochromatic light was used, size-selective photoetching could be conducted; the photoetching proceeded until the band gap energy of the CdTe QDs increased to the energy corresponding to the wavelength of the irradiating light. As a result, a good linear relationship was obtained between the wavelength of the irradiating light and that of the fluorescence peak. The resulting CdTe QDs exhibited a fluorescence peak with an FWHM value as small as 23.5 nm, indicating preparation of highly monodispersed nanocrystals. The high quantum yield (ca. 45%) was maintained after the photoetching. Very fine tuning of the fluorescence wavelength with 2 nm resolution was achieved by changing the wavelength of the irradiating light by 2 nm. Theoretical calculation of the quantum size effects (effective mass approximation) predicts that a difference in the band gap fluorescence wavelength of 2 nm corresponds to a change in particle diameter of ca. 0.02 nm.

Local Intra-Arterial Fibrinolysis in Acute Basilar Artery Occlusion

Acute basilar artery (BA) occlusion is typically associated with poor outcome; however newer diagnostic and treatment modalities have the potential to improve prognosis. In this study, six patients with acute BA occlusion were followed and the effectiveness of local intra-arterial fibrinolysis (LIF) and subsequent percutaneous transluminal angioplasty (PTA) with a balloon catheter were assessed. Of the six patients with BA occlusion observed in this study, two had extended brain stem infarction on diffusion weighted image (DWI) and were treated conservatively. The other four patients received LIF at an average of 5.2 hours from occlusion onset. Three of these four patients received additional PTA with compliant balloon catheters. All four of the patients who received LIF achieved recanalization of the BA trunk and showed a favorable clinical outcome. These findings suggest that LIF is beneficial for selected patients with BA occlusion and that successful recanalization is indicative of a good prognosis. Because of the poor prognosis associated with conservative therapy, we conclude that LIF should be attempted even for comatose patients or in cases of prolonged occlusion time.

Carotid-compression technique for the insertion of guiding catheters

Inserting a guiding catheter into a tortuous artery for neurointerventional procedures can be difficult. In our technique, the carotid artery is manually compressed to stabilize and/or straighten the inserted wire before advancing the guiding catheter. Although this technique is not risk-free and care must be taken to avoid vascular injury by excessive compression, it is useful for the insertion of a guiding catheter into the carotid artery.

Antihypertensive effect of gamma-amino butyric acid enriched soy products in spontaneously hypertensive rats

The effect of gamma-amino butyric acid (GABA)-enriched soybean on blood pressure was investigated in male spontaneously hypertensive rats. Ten-week-old rats were given diets containing graded levels of GABA-enriched soybean powder for 8 weeks. The systolic blood pressure in rats fed 0.15% GABA diet was significantly lower at 1st week and maintained lower values for 4 weeks as compared with 0% GABA controls. No effect on blood pressure was found in those of 0.03 and 0.3% GABA. The results suggest that there exist appropriate dietary GABA level to get the blood pressure lowering effect.

Daily bowel movements and Escherichia coli O157 infection

The usual bowel habits of 259 school age children before the large outbreak of E coli O157 infection in Sakai City in the summer of 1996 were investigated. A daily morning movement and/or frequent bowel movements may be a protective factor against infection, while being constipated contributed to a worsening of symptoms.

Clinical utility of capillary polymerase chain reaction for diagnosis of Cytomegalovirus pneumonia

The purpose of this retrospective study was to assess the diagnostic efficacy of CMV DNA detection by capillary PCR in patients with interstitial pneumonia. Of 882 samples taken from 363 patients, 317 were obtained from sputum, 94 from BAL fluid, 291 from blood and 180 from urine. PCR for CMV was positive in 58 samples (6.6%), with positive detection for 6.9% of sputum, 10.6% of BAL fluid, 4.1% of blood and 7.8% of urine samples. CMV pneumonia was diagnosed retrospectively in 34 (9.4%) of the 363 patients by demonstration of CMV antigen-positive cytomegalic inclusion bodies in lung tissue sections. The positive and negative predictive values were 100% (10/10) and 98.8% (83/84) for the BAL fluid samples and 95.5% (21/22) and 99.7% (294/295) for the sputum samples, respectively. Clinical sensitivity and specificity were 90.9% (10/11) and 100% (83/83) for the BAL fluid samples and 95.5% (21/22) and 99.7% (294/295) for the sputum samples, respectively. However, the blood and urine samples showed poor clinical sensitivity and low positive predictive values. We suggest that the use of capillary PCR for BAL fluid and sputum samples is very useful for diagnosing CMV pneumonia in patients with interstitial pneumonia in whom CMV pneumonia is suspected.

CD3+CD4-CD8-TCR-alphabeta+ T-cell lymphoma with clinical features of primary effusion lymphoma: an autopsy case

We report an unusual case of T-cell lymphoma presenting as ascites. A 72-year-old HIV-negative woman was admitted to our hospital for abdominal discomfort associated with increasing abdominal girth over the course of 1 month. Physical examination showed a tense and distended abdomen and edema of the lower extremities. There was no hepatosplenomegaly or lymphadenopathy. A computed tomographic scan of the abdomen and chest showed massive ascites and pleural effusions, but there was no evidence of tumor masses or lymph node enlargement. The cytospin prepared from the peritoneal fluid was hypercellular and composed of a population of monotonous, large cells containing fine chromatin. No herpesvirus-8 (HHV-8) DNA was detected by polymerase chain reaction in the cells. Immunohistochemistry showed the neoplastic cells to be CD3+, CD4, CD7+. CD8-, CD34-, CD56, and TCR-alphabeta+. Repeated cytogenetic studies showed common abnormalities of del(1) (p11p22), +i(7)(ql0), and t(11:14)(q23;q11). The morphologic and immunologic findings were suggestive of peripheral T-cell lymphoma (PTCL), unspecified. This case suggests that some PTCLs with clonal chromosomal aberrations can exhibit peculiar serosal spreading in the absence of HHV-8 infection.

Interleukin-4 is needed for the infection of monocytes by human cytomegalovirus

OBJECTIVE

We studied the ability of human cytomegalovirus (HCMV) to infect peripheral blood mononuclear cells (PBMC) pretreated with or without Th2-cytokine interleukin-4 (IL-4) in vitro.

METHODS

Adherent cells and nonadherent cells were obtained from PBMC. We inoculated these cells with HCMV at concentrations ranging from 0 to 10 ng/ml of IL-4. Immediate-early antigen-1 (IE-1) and glycoprotein H (gH) mRNAs were detected using the reverse-transcription polymerase chain reaction.

RESULTS

IE-1 and gH mRNAs could be detected in monocytes pretreated with IL-4. In contrast, no IE-1 mRNA was detected in monocytes pretreated without IL-4. We tested whether higher infectious titers could result in the infection of monocytes whether or not they were pretreated with IL-4. However, no IE-1 mRNA was detected in the monocytes not pretreated with IL-4. To elucidate how HCMV-infected monocytes affect lung tissue, human embryonic lung fibroblasts MRC-5 were cocultured with HCMV-infected monocytes. The cytopathic effects of HCMV were observed microscopically and was confirmed by direct immunoperoxidase staining with a human monoclonal antibody against the HCMV IE-1.

CONCLUSION

Our data strongly suggest that the ability of HCMV to infect monocytes may correlate with the presence of IL-4.

Taurine inhibits development of atherosclerotic lesions in apolipoprotein E-deficient mice

1. The effects of taurine on the development of atherosclerotic lesions were investigated in apolipoprotein (apo) E-deficient mice, an animal model with severe hypercholesterolaemia and extensive atherosclerosis. These mice were fed a normal laboratory chow containing 2% taurine for 12 weeks. 2. Serum total cholesterol was significantly elevated after 12 weeks treatment with taurine. This elevation was due to increases in very low-density lipoprotein- and low-density lipoprotein-cholesterol. 3. Despite such effects on serum lipoproteins, analysis using en face oil red O staining revealed that taurine reduced the area of arterial lipid accumulation by 28%, as measured quantitatively as an index of atherosclerosis. Histological examination also demonstrated a decrease in the size of aortic lesions in taurine-treated mice. 4. Serum levels of thiobarbituric acid reactive substances (TBARS) in apoE-deficient mice were higher than in normolipidaemic C57BL/6J mice. Serum TBARS levels were significantly decreased by 12 weeks treatment of apoE-deficient mice with taurine. 5. Thus, taurine prevents the formation of atherosclerotic lesions, independently of serum cholesterol levels, and the results suggest that the anti-oxidative effects of taurine are related to its anti-atherosclerotic actions.

In vitro transmission of HCMV between fibroblasts and peripheral blood leukocytes in the presence of IL-4

We demonstrated transmission of human cytomegalovirus (HCMV) from the human lung fibroblast MRC-5 to peripheral blood leukocytes (PBLs). mRNA of the HCMV immediately-early (IE) antigen was detected in PBLs cultured with IL-2 or IL-2 + IL-4 that made direct contact with HCMV-infected MRC-5, whereas it was not detected in PBLs prevented from making cell-to-cell contact. However, mRNA of HCMV IE was not detected in PBLs cultured with IL-2 and IFN-gamma that made direct contact with HCMV-infected MRC-5. Transmission of the pp65 antigen was increased in culture medium containing IL-4. At a higher viral infection titer, cell-free HCMV infected adherent PBLs cells. The subset, which did not adhere, did not infect cell-free viruses even at a very high multiplicity of infection. Moreover, the adhered subset of PBLs infected with HCMV was able to transmit HCMV to non-infected fibroblasts. Our results suggest that cell-to-cell contact (when PBLs make direct contact with HCMV-infected cells) is important in the mechanism of HCMV transmission and that the adherent cells of PBLs are one of the most important vehicles for HCMV infection. Moreover, we suggest that type 2 cytokines such as IL-4 enhance the transmission of HCMV to PBLs.

[High-dose therapy and peripheral blood stem cell transplantation for patients with aggressive non-Hodgkin's lymphoma remaining in initial remission: results of a feasibility study]

High-dose therapy with peripheral blood stem cell transplantation (HDT/PBSCT) was performed as one aspect of front-line therapy in patients with poor-risk aggressive non-Hodgkin's lymphoma (high-intermediate/high risk) according to the age-adjusted international prognostic index (aaIPI). Twenty-nine patients were enrolled in this study between November 1994 and March 1999. CHOP + etoposide (CHOP-E) was used as an initial chemotherapy and as a chemotherapy agent for the purpose of cell harvesting. Peripheral blood stem cells were harvested from 17 patients, and HDT with CEC (carboplatin, etoposide, cyclophosphamide)/PBSCT was performed in 11 patients. Eighteen patients dropped out, including five for whom CHOP-E therapy was ineffective and 5 who did not give consent for cell harvesting or HDT/PBSCT. CHOP-E therapy produced complete remission (CR) in 15 out of 26 patients (58%) after discounting the 3 who were ineligible among the 29 who were initially enrolled. The median observation period after PBSCT in the 11 patients who underwent HDT/PBSCT was 25 months (3 to 50 months), and the 3-year disease-free survival rate was 73%. No serious complications associated with the transplantation were observed. We were able to confirm the feasibility and safety of HDT/PBSCT as one form of front-line therapy for aggressive non-Hodgkin's lymphoma in patients under 60 years of age.

Hybridization of non-sulfonylurea insulin secretagogue and thiazolidinedione-derived insulin sensitizer

Hybrid compounds of non-sulfonylurea insulinotropic agents and thiazolidinedione-derived insulin-sensitizing agents were designed and synthesized. The benzylidenesuccinic acid derivative 24 was equal both to nateglinide in potency of insulin-releasing activity and to pioglitazone in insulin-sensitizing activity.

Chorioamnionitis decreased incidence of respiratory distress syndrome by elevating fetal interleukin-6 serum concentration

Respiratory distress syndrome (RDS) of newborns is one of the most important factors determining neonatal morbidity and mortality. The interleukin-6 (IL-6) titre in cord sera of RDS-free neonates born to mothers with histological chorioamnionitis was significantly higher than that in RDS-complicated neonates without chorioamnionitis. Maternal administration of glucocorticoid suppressed the IL-6 concentrations in the cord sera of fetuses with chorioamnionitis. The fetuses without chorioamnionitis who suffered from RDS even after maternal glucocorticoid administration showed a similar IL-6 titre to that of RDS-affected neonates without chorioamnionitis. Examination of the mechanism by which IL-6 decreased the incidence of fetal RDS revealed that H441-4, a human pulmonary adenocarcinoma cell line, stimulated with recombinant (r)-IL-6 started the synthesis of mRNA and protein of pulmonary surfactant protein (SP)-A. The present study shows that IL-6 elevation in fetuses with chorioamnionitis promotes fetal lung maturation by inducing SP-A synthesis, thereby decreasing the incidence of RDS in the preterm neonates.

Clinical use of capillary PCR to diagnose Mycoplasma pneumonia

In the present study, serologic data were compared with data obtained by capillary PCR to establish the efficacy of capillary PCR for the determination of Mycoplasma infection in samples obtained from throat swabs, bronchoalveolar lavage fluids (BALF), and sputum of patients with Mycoplasma pneumonia. We performed PCR analysis for Mycoplasma DNA on a total of 325 samples from 197 patients with community-acquired pneumonia and in whom Mycoplasma pneumonia was suspected. There were 68 PCR-positive specimens. Review of the differences in PCR positivity rates based on the site of specimen collection showed the highest rate of detection (28.6%) from throat swabs. From among the 31 patients with significantly elevated titers of serum Mycoplasma antibodies, the PCR results were positive for 25 patients. Thus, capillary PCR had a sensitivity of 80.6% (25 of 31). Five of the six false-negative results were from throat swab specimens. Moreover, testing (PCR) had been performed only once for these five patients with false-negative results. From among the PCR-positive findings from BALF specimens, there were no false-positive results. BALF specimens were very useful, except for the technical procedures and increased patient burden required to obtain these specimens. We suggest that the use of throat swab specimens in capillary PCR is much more suitable for diagnosing Mycoplasma pneumonia in routine clinical practice; however, careful throat swab specimen collection and an increase in the number of times that the PCR is performed are necessary to reduce the rate of false-negative results.

Upregulation of heme oxygenase gene expression in rat lung epithelial cells following exposure to cadmium

Inhalation exposure to cadmium (Cd) is associated with inflammatory lesion in the lung. In the present study we have investigated cytotoxic effects of Cd on immortalized rat lung epithelial cells (SV40-T2) and gene expression in those cells following in vitro exposure to sublethal concentrations of cadmium chloride (CdCl(2)). The polymerase chain reaction (PCR)-based subtraction method was used to find differentially expressed genes between control and Cd-exposed SV40-T2 cells. The most prominent cDNA on an agarose gel was identical to a fragment of rat heme oxygenase (HO) gene. Northern blot analysis indicated that the level of HO mRNA expression in SV40-T2 cells was increased to 38-fold of the control value following exposure to 2.5 microM CdCl(2) for 4 h. These results suggest that HO gene expression is one of the most sensitive biomarkers for acute exposure to Cd in the lung.

Changes of immunological markers after autologous peripheral blood stem cell transplantation

PURPOSE

Recently high-dose chemotherapy with peripheral blood stem cell transplantation (PBSCT) has become an important treatment for hematological and solid tumors.

METHODS

Immunological parameters were examined before and after PBSCT in 9 patients with lung cancer and 13 patients with malignant lymphoma. Findings were compared with those for bone marrow transplantation (BMT). Peripheral blood cells were analyzed for phenotype and the levels of cytokines and soluble factors were measured.

RESULTS

After PBSCT, activated T cells (CD3+HLA-DR+ cells, CD8+HLA-DR+ cells) and suppressor/cytotoxic T cells (CD8+CD11b- cells) were significantly higher in the patients with lung cancer than in those with malignant lymphoma. Serum levels of interleukin-4 and soluble interleukin-2 receptor were also significantly higher in the patients with lung cancer than in those with lymphoma. On the other hand, the serum levels of interferon gamma, tumor necrosis factor alpha, interleukin-6, soluble human leukocyte antigen class 1, and soluble thrombomodulin were significantly increased after bone marrow transplantation. The transfused peripheral stem cells of lung cancer and lymphoma patients had a similar number of granulocyte/macrophage-colony-forming units, but lung cancer patients had significantly more CD34-positive cells.

CONCLUSION

By reinfusing large numbers of autologous immune cells, PBSCT may accelerate immune reconstitution, with T cells being likely to have a marked therapeutic potential. The changes after PBSCT were greater in patients with lung cancer than in lymphoma patients. These blood cells are potent mediators of anticancer activity and could play an important role in the elimination of autologous malignant cells.

Significance of acute cerebral swelling in patients with sylvian hematoma due to ruptured middle cerebral artery aneurysm, and its management

A retrospective study of 75 patients treated surgically for ruptured middle cerebral artery (MCA) aneurysm within 48 hours evaluated clinical grade at admission, secondary development and management of cerebral swelling associated with space-occupying hematoma, cerebral infarction caused by vasospasm, development of hydrocephalus, and clinical outcome. Clinical grade at admission was significantly better in patients without than in those with hematoma (p < 0.01). Twenty-seven patients with sylvian hematoma caused by ruptured MCA aneurysm often developed ipsilateral cerebral swelling in the early period after subarachnoid hemorrhage. Seventeen of these patients developed serious cerebral swelling and received barbiturate therapy. Nine of these 17 patients had good outcome, but six patients died of cerebral swelling. The incidence of hydrocephalus was significantly higher in patients with than in those without hematoma (p < 0.01). The incidence of infarction was more pronounced in patients with sylvian hematoma. Clinical outcome was significantly better in patients without than in those with sylvian hematoma (p < 0.01). Development of cerebral swelling in patients with sylvian hematoma due to ruptured MCA aneurysm has a significant effect on outcome, and improvements in management are required.

Differences among acute, subacute, and chronic chorioamnionitis based on levels of inflammation-associated proteins in cord blood

The serum concentration of inflammation-associated proteins and several complement components in the cord blood of 215 newborns with and without chorioamnionitis (CAM), who were delivered between 17 and 42 weeks of gestation, were measured. We investigated the relationship of levels of serum proteins to acute, subacute, and chronic CAM, and to subacute necrotizing funisitis (SNF). Complement components C3d, C3, and C4 levels increased in subacute CAM (P = 0. 0002, P = 0.0007, P = 0.0029, respectively), whereas factor B increased in each type of CAM (P = 0.0001, P = 0.0009, P = 0.0004, respectively). Among the immunoglobulins, IgG levels were unrelated to the presence or type of CAM, IgM levels increased in subacute CAM (P < 0.0001), and IgA levels increased in chronic CAM (P < 0.0001). Among the acute phase reactants (APR), haptoglobin and C-reactive protein (CRP) levels increased in acute (P < 0.0001, P = 0.0022, respectively) and chronic CAM (P = 0.0035, P = 0.0345, respectively), whereas orosomucoid levels increased in chronic CAM (P = 0.0003). IL-6 levels increased in acute (P = 0.0011) and subacute (P = 0. 0475) CAM. C3d (P = 0.0063), C3 (P = 0.0289), C4 (P = 0.0491), and IgM (P < 0.0001) levels were increased in SNF. These findings suggest that the histologic distinction of acute, subacute, and chronic CAM is a useful indicator of the inflammatory mediator status of the infants. The infants with SNF may have ended their initial active inflammatory states, but they still have subacute immune activation.

[Anti-fibrinogen antibody detected in a patient with systemic lupus erythematosus and disseminated intravascular coagulation]

A 22-year-old woman was admitted to our hospital with fever, generalized lymphadenopathy, and pancytopenia in February 1995. She was diagnosed as having systemic lupus erythematosus (SLE) based on positivity for anti-nuclear antibody, and polyarthritis among other findings. A diagnosis of disseminated intravascular coagulation (DIC) was made based on the increase of FDP and other data (DIC score: 7). We also detected an anti-fibrinogen antibody. Lymph node biopsy revealed subacute necrotizing inflammation and there were on signs of the hemophagocytic phenomenon in bone marrow. The DIC score improved and the anti-fibrinogen antibody disappeared in association with the response of SLE to prednisolone therapy. The onset of SLE associated with DIC has never been reported before, as far as we could determine. The mechanism of DIC associated with SLE may be related to endothelial damage caused by immune complexes.

[A boy highly suspected of Shwachman syndrome]

We encountered a boy highly suspected of Shwachman syndrome. The affected child presented a mild disturbance of the extrapancreatic secretory function followed by a marked decrease in the number of peripheral blood neutrophils and contracted respiratory infections repeatedly. The neutrophilic function of the affected child showed the disturbance of motility both in vivo and in vitro. So the impairment of the neutrophil itself was considered accountable for it. After admission, he contracted a variety of viral infections and then showed an increase in the number of peripheral blood neutrophils. Furthermore, the disturbance of the extrapancreatic secretory function is also improved slowly. Shwachman syndrome is a rare disease in Japan. From the clinical course of this case, it may be reasonable to infer that there are various variant types in Japan.

Transfer of autoimmune thyroiditis and resolution of palmoplantar pustular psoriasis following allogeneic bone marrow transplantation

We report an unusual case of a patient who was cured of one autoimmune disease (palmoplantar pustular psoriasis (PPP)) but developed another autoimmune disease (autoimmune thyroiditis) after allogeneic BMT. A 40-year-old man suffering from AML with PPP underwent allogeneic BMT from his HLA-identical sister for the treatment of AML. The patient experienced complete clearance of the cutaneous PPP despite the cessation of immunosuppressive therapy for over 2 years. However, he developed hyperthyroidism with anti-thyroglobulin antibodies 5 months after BMT, although he had showed normal thyroid functions without anti-thyroglobulin antibodies before BMT. The donor had no history of thyroid diseases and showed normal thyroid functions but was positive for anti-thyroglobulin antibodies. Thus, even when the donor is in a subclinical state, autoimmune thyroiditis may be transferred from donors to recipients by BMT.

Expression of gelatinase A, tissue inhibitor of metalloproteinases-2, matrilysin, and trypsin(ogen) in lung neoplasms: an immunohistochemical study

Lung cancer is a heterogeneous tumor in terms of clinical and biological behavior, and its aggressiveness depends on its invasive and metastatic properties. Matrix metalloproteinases and serine proteinases are believed to play a crucial role in invasion and metastasis of malignant tumor cells. In the present study, the authors evaluated immunohistochemically the expression of gelatinase A; tissue inhibitor of metalloproteinases-2 (TIMP-2), an inhibitor of gelatinase A; matrilysin; and trypsin(ogen) in 67 lung tumors from a variety of histological types including 17 squamous cell carcinomas, 16 adenocarcinomas, 15 small cell carcinomas, and 12 carcinoids. Interestingly, normal bronchial, bronchiolar, and alveolar epithelial cells expressed gelatinase A, TIMP-2, matrilysin, and trypsin(ogen) at varying frequencies and intensities. Bronchial smooth muscle cells and cartilage cells expressed gelatinase A alone, whereas endothelial cells, fibroblasts, and macrophages expressed gelatinase A and TIMP-2. Gelatinase A was expressed at high levels in most lung tumors examined (47% to 80%). TIMP-2 was also expressed at high levels except in the small cell carcinomas, which showed TIMP-2 expression at a lower frequency (60%) compared with other types of lung tumors (80% to 100%). Although matrilysin was expressed by tumor cells of all the histological types at various frequencies (13% to 63%), its expression was most common in adenocarcinomas. Expression of trypsin(ogen) was observed almost exclusively in adenocarcinomas (56%); other types of lung tumors expressed trypsin(ogen) far less frequently (0% to 12%). The present results, taken together with those of previous studies, suggest that gelatinase A is associated with malignant behavior of all the types of lung tumors, whereas its activity may be controlled by the endogenous inhibitor TIMP-2. The aggressive clinical behavior of small cell carcinoma may be attributable, at least in part, to a loss of the inhibitory effect of TIMP-2, as a significant proportion of these tumors showed negative or low levels of TIMP-2 expression. Matrilysin and trypsin(ogen) expressions are unlikely to be correlated with the aggressiveness of lung tumors. The expression of trypsin (ogen) may rather reflect the differentiation of adenocarcinoma cells toward normal airway epithelial cells.

Early administration of Bifidobacterium breve to preterm infants: randomised controlled trial

AIM

To investigate the colonisation with Bifidobacterium breve of the bowels of very low birthweight (VLBW) infants.

METHODS

The adverse effects of B breve were examined in 66 VLBW infants (preliminary study). A prospective randomised clinical study of 91 VLBW infants was also completed and these infants were followed up for three years. Precise viable bacterial counts of serial stool specimens were examined for the first eight weeks after birth in 10 infants. The colonisation rates of administered bacteria were examined using immunohistochemical staining of stool specimens with a B breve specific monoclonal antibody.

RESULTS

In the preliminary study there were no side effects attributable to the bacteria. Immunohistochemical staining of stool specimens showed that the colonisation rates of the administered bacteria were 73% at 2 weeks of age, but only 12% in the control group. Early administration of B breve significantly decreased aspirated air volume from the stomach and improved weight gain.

CONCLUSIONS

B breve can colonise the immature bowel very effectively and is associated with fewer abnormal abdominal signs and better weight gain in VLBW infants, probably as a result of stabilisation of their intestinal flora and accelerated feeding schedules.

[A boy highly suspected of hypersensitivity pneumonitis characterized by generalized mucosal lesions]

The case is a boy who developed progressive dyspnea and had since been followed over a long period time as a case of unknown fever without respiratory symptoms. He showed mucosal symptoms such as intraoral aphtha, eosinophilic pyuria and diarrhea and was clinically diagnosed as hypersensitivity pneumonitis. The affected child showed high levels of circulating immune complex, a decline in DLco on the respiratory function test and a decrease in CD 4/8 in bronchoalveolar lavage lymphocytes; furthermore, an antibody specific to Aureobasidium pullulans was positive in the precipitated antibody test. As for the immune function of the affected child during the follow-up, hypergammaglobulinemia and various immune abnormalities were observed. We thought the clinical feature of the affected child to be of pathophysiological value in dealing with unknown fever in childhood, so we reported our findings in this paper.

[Seven cases of hemophagocytic syndrome complicated with childhood collagen diseases]

We encountered seven children with hemophagocytic syndrome complicated with collagen diseases of whom five were JRA and two SLE, HPS was seen as one of initial symptoms in 6 cases excluding one case of JRA. Hematologically, cytopenia in 2 cell lines (RBC and platelets) was seen in most cases. Active hemophagocytosis by matured large histiocytes was observed in all cases. All patients had moderately to extremely high serum ferritin levels and LDH levels. Although both lives did not correlated with prognosis in HPS with collagen disease, the higher serum total cholesterol/serum triglyceride ratio, the worse was the prognosis. Those findings suggested that HPS in collagen diseases may be a different entity from other types of HPS.

[A 12-year-old girl with acute respiratory disease with pneumonia caused by adenovirus type 7]

We have encountered a 12-year-old girl with acute respiratory disease including pneumonia caused by adenovirus type 7. While being followed-up for bronchial asthma, she developed this disease with dyspnea accompanied by high fever, pharyngalgia and a dry cough subsequent to a slight fever. Adenovirus type 7 was separated and identified from the pharyngeal smear. Additionally, perfusion scintigraphy of the lungs presented evidence of interstitial pneumonia. with these findings and the clinical course put together, this case was diagnosed as having acute respiratory disease with pneumonia caused by adenovirus type 7. Thereafter, perfusion scintigraphy of the lungs continued showing interstitial shadows, which suggested the presence of severe sequlae of the lung. Formerly the separation rate of adenovirus type 7 was low in Japan, but the rate has tended to increase in cities in recent years. Cases presenting such acute, severe respiratory symptoms are expected to increase in the future, and clinically we consider to be our case important enough to be reported.

Effect of chorioamnionitis on the levels of serum proteins in the cord blood of premature infants

OBJECTIVE

To determine the relationships among complements, other serum proteins (including acute-phase reactant), and the cytokine interleukin-6.

DESIGN

Prospective observational study.

SETTING

A perinatal center, children's hospital, and research institute in Osaka, Japan.

PATIENTS

Two hundred fifteen newborn infants ranging from 17 to 42 weeks in gestational age.

MAIN OUTCOME MEASURES

We measured the serum levels of several proteins and complements in the cord blood of neonates with and without chorioamnionitis by immunological assays.

RESULTS

The levels of C3d, haptoglobin, interleukin-6, IgM, C-reactive protein, and IgA were not influenced by gestational age, and levels of C5, C1q, C2, albumin, C9, and IgG were not influenced by chorioamnionitis status. The levels of C3, C4, CH50, factor B, and orosomucoid were influenced by both factors.

CONCLUSIONS

Our investigation of the mutual relation of the data suggests that the increase of cytokine interleukin-6 affects each other component. We suggest that, compared with the serum levels of proteins in neonates with chorioamnionitis, levels in neonates without chorioamnionitis are more similar to those in the normal fetus.

[TIMPs (tissue inhibitors of metalloproteinases): their species, functions and effects on tumor metastasis]

TIMPs (tissue inhibitors of metalloproteinases) belong to a family composed of three members: TIMP-1, -2 and -3. They possess a high degree similarity in their structure including 12 conserved cystenyl residues at the same relative positions. Recently, they have been shown to inhibit not only proteolytic activities of metalloproteinases but also tumor cells metastasis in vitro and in vivo. In this review, we summarize their structure information, inhibitory mechanism of metalloproteinases, TIMPs-like secretory inhibitors, other biological functions of TIMPs such as growth-regulating activity, their chromosomal localizations and related diseases. We also mention their inhibitory effects on tumor cells metastasis in vitro and in vivo, and their clinical applications.

A patient with Schinzel-Giedion syndrome and a review of 20 patients

The Schinzel-Giedion syndrome is characterized by severe midface retraction, multiple skull anomalies, clubfeet, and cardiac and renal malformations. So far, 20 patients have been reported. This is the first report of the syndrome demonstrated in Oriental patients. In surviving patients, severe growth and developmental deficiency is a common finding.

[Chronic cytomegalovirus infection that present specific clinical course--a case of a boy with common variable immunodeficiency]

We describe an 8-year-old boy with CVID and chronic CMV infection. Although at onset he was diagnosed as IgA deficiency, 4 years after his clinical manifestations because compatible to CVID. During his clinical course he had suffered from various disorders as follows; AIHA, interstitial pneumonia, hemophagocytic syndrome, chronic gastroenterocolitis and so forth. At the age of 8 the PCR of CMV-DNA of biopsy specimen from colon, lung and bone marrow were confirmed to be positive. Hematological examinations revealed abnormal cellular immunity such as decreased CD 4/8 ratio with increased HLA- DR+ CD 8+ T cell, decrease of absolute blood lymphocytes count and reduced response of lymphocytes to blastogenetic agents. These findings brought us to diagnose him as having CVID complicated with chronic CMV infection. This case gives us some impact to speculate what role CMV infection plays in CVID, Whose etiology is unknown.

[Effective combination therapy by recombinant erythropoietin and cepharanthin in a girl with refractory anemia]

A 3-year-old girl was admitted with a one-month history of a tendency to bleed to Jikei Kashiwa hospital in May, 1992. She developed pancytopenia as follows; hemoglobin: 8.6 g/dl, red blood cell: 316 x 10(4)/microliters, reticulocyte: 9,480/microliters, white blood cell: 2,500/microliters (neutrophil: 400/microliters) and platelet count: 2.7 x 10(4)/microliters. Her bone marrow was hypoplastic, but was so dysplastic in 3 cell-lines as to be diagnosed as hypoplastic refractory anemia. After two courses of methylprednisolone pulse therapy followed by oral prednisolone therapy which were not effective and were supplemented by blood transfusions, the treatment of 20mg/day oral Cepharanthin, a biscoclaurine alkaloid, and intravenous recombinant human erythropoietin (rhEPO) twice a week at dose of 6,000 U/week was initiated in January, 1993. About 3 months later she showed a steady rise in hemoglobin concentration (from 4.1 to 11.9 g/dl) and platelet count (from 4,000 to 39,000/microliters). Although the rhEPO was tapered and ceased in September, 1993, her hemoglobin concentration has ranged from 11.0 to 11.9 g/dl and her platelet count from 30,000 to 40,000/microliters by giving her Cepharanthin and low dose prednisolone.

[A case of pure red cell aplasia associated with sodium valproate therapy]

We reported a 14-year-old female with petit mal epilepsy who suffered from pure red cell aplasia 12 weeks after sodium valproate (VPA) therapy started. On admission she presented anemia but no jaundice. Her hemoglobin was 5.4g/dl and bone-marrow biopsy revealed hypocellularity with erythroid hypoplasia. The Direct Coombs' test and anti-nucleotide antibody were positive. Reticulocytosis occurred 10 days after discontinuation of VPA. The Direct Coombs' test became negative one year after discontinuation of VPA. In general, drug-induced PRCA is caused by toxic or allergic agents, but this case suggests the immune mechanism of VPA-induced PRCA.

Ultrastructural localization of myeloperoxidase activity in acute monoblastic leukemia

In five patients with acute monoblastic leukemia (AMoL), the ultrastructural localization of myeloperoxidase (MPO) activity was investigated by two methods, one generally used for the detection of MPO and the other for the detection of platelet peroxidase. The MPO-positive rate achieved was lower with the former method than with the later, indicating that MPO is degraded during the fixation of AMoL cells for electron microscopy. If the ultrastructural MPO positivity of leukemic cells varies when different detection methods are used, the possibility of monocytic leukemia should be considered.